Effective January 1, 2026, the Community Spouse Resource Allowance will increase to $162,660.00. The combined resource allowance will increase to $164,660.00. The Community Spouse income allowance will increase to $4,066.50. The SSI monthly rate in 2026 will be $994, so the 2026 Medicaid income cap will be $2,982. In general terms, all 2025 rates and […]
Blog
On November 15, 2024, the Centers for Medicare and Medicaid Services posted the 2025 spousal impoverishment standards. These are the standards used to determine how the amount of income and resources that can be diverted to or retained by a Community Spouse. They also tell us the SSI rate and the Medicaid income cap. In […]
When the Deficit Reduction Act of 2005 changed 42 U.S.C. § 1396p, new restrictions were imposed on promissory notes. Subsection (c)(1)(I) note provides that the purchase of a promissory notes is treated as a transfer subject to the penalty rules unless the note meets the following guidelines: (I) For purposes of this paragraph with respect […]
In Lamle ex rel. Lamle v. Shropshire (W.D. Oklahoma 5/29/2024), a United States District Court upheld a denial of benefits where three Medicaid applicants refused to answer questions about promissory notes. Penelope Lamle, Marilyn Garrison and Maxine Houston each loaned money to others in exchange for a promissory note. Lamle and Garrison made loans to […]
Section 1115 of the Medicaid statute allows sates to test new or existing ways to deliver and pay for health care services in Medicaid and the Children’s Health Insurance Program (CHIP). The home health waivers are designed to meet the needs of people who prefer to get long-term care services and supports in their home […]
Medicaid Post Eligibility Treatment of Income and Incurred Medical Expenses After Medicaid eligibility is established, 42 C.F.R. § 435.725 addresses how income is treated. For clarity, if the Medicaid recipient is married,income of the non-recipient spouse does not count toward eligibility and is not part of the patient cost share. Specifically, 42 U.S.C. § 1396r-5(b)(1) […]
In Parker v. Louisiana Department of Health (April 30, 2024), the U.S. District Court for the Eastern District of Louisiana granted a motion for preliminary injunction prohibiting the State from terminating a grandmother’s QI Medicaid based on the State’s determination of family size. The Plaintiff, a 71 year old widow who was raising her grandchild, […]
The federal Medicaid statute authorizes the use of individual self-settled special needs trusts for individuals under the age of 65. See 42 U.S.C. § 1396p(d)(4)(A). It also authorizes any applicant, regardless of age, to establish a self-settled pooled special needs trust sub-account. 42 U.S.C. § 1396p(d)(4)(C). An open question not addressed in (d)(4)(C) is whether […]
On March 27, 2024, the Social Security Administration published a final rule in the Federal Register which changes its calculation of In-Kind Support and Maintenance (ISM). Under the prior rule, if food and/or shelter is provided to a recipient of Supplemental Security Income (SSI), the income is deemed to the recipient, reducing his or her […]
